LTC Pharmacy News
October 2016
Long Term Care Pharmacy, like the rest of the healthcare industry, experiences constant change, from new legislation to changes in existing regulation, it's hard to keep up. Make your life a little easier by keeping in touch through
See Video Overview of Final LTC Facility Rule
The long-awaited CMS final rule on long term care facilities has been published. Take a tour of the pharmacy-related provisions here.

We also have a video overview of the CMS SNF PPS Final Rule for FY 2017
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CMS Releases Final LTC Rule
On October 4th, CMS published the final rule on conditions of participation in Medicare and Medicaid for long term care facilities. 

The rule updates standards for LTC facilities, establishing new requirements and timelines for implementation. CMS has enhanced the role of pharmacists and pharmacies and creates a focus on the use of antipsychotic drugs and antibiotics. 

Beginning in November, 2017 consultant pharmacists will be required to review the resident's medical record during each monthly drug regimen review and will need to send the report of irregularities to the attending physician, the medical director and director of nursing. The attending physician must also document what actions have been taken in response to the findings of the pharmacist.

See video overview of the rule

CDC Adds Opioid Abuse Resource
The Centers for Disease Control published a resource for pharmacists on the important role pharmacists play in identifying and preventing opioid abuse.

MedPAC Discusses Part B Drugs and Part D Biosimilars
The Medicare Prospective Payment Commission met in October and discussed options for changes to the Medicare Part B drug program, which included changing the reimbursement formula and limiting the increase in average sales price calculations. 

The Commission also reviewed rising cost of specialty drugs and the potential impact of the introduction of biosimilar medicines. MedPAC staff note that these drugs have the potential to help control drug spending in Medicare, but there are cultural and regulatory barriers to success. 

ACL Reports on Quality in HCBS
The Agency for Community Living announced the completion of a report for the National Quality Forum on Quality in Home and Community-Based Services to Support Community Living: Addressing Gaps in Performance Measurement. As Medicaid programs are increasingly trying to move the elderly away from nursing homes and toward home and community based care, the measures needed to evaluate these services need to evolve.

AHRQ Tools to Combat Healthcare Associated Infection
The Agency for Healthcare Research and Quality has published a resource guide to help healthcare professionals identify and eradicate healthcare-related infections. The list is quite comprehensive and covers a wide variety of infections.

National Academies of Science: Families Caring for an Aging America
Nearly 18 million Americans are caring for an aging relative or friend. This report identifies the characteristics of caregivers and discusses the looming crisis as families become smaller and the population continues to age. See report.
Congress Currently in Recess
Congress is currently in recess and will return following the election.

Members of Congress Criticize CMS Experiments
The Hill reports on a letter to CMS from 179 lawmakers criticizing the Center for Innovation's aggressive action to implement broad-based demonstrations. Of special note is the Center's announcement of a demonstration to change Medicare Part B drug reimbursement without rulemaking or legislative authority.
Federal Agency News
Go to the LTC Pharmacy website for regular updates on what's coming from CMS, including proposed and final rules, new programs, news from Medicare and Medicaid and updated Medicare Learning resources. Go there now.

The FDA often updates its website with drug safety information, news about drug approvals and implementation information on laws, such as the Drug Quality and Security Act. Keep checking our site for the latest news from FDA.

THE HHS Office of Inspector General publishes audit reports and results of investigations on federal health programs, such as Medicare and Medicaid. Congress frequently looks at these reports when deciding where to focus on oversight and legislation. Keep in touch here.

The Government Accountability Office is the official investigative arm of Congress and publishes important reports that often guide the national conversation. We keep track of announcements coming out of GAO, so you don't have to. All you need to do is click here.

News Items of Interest
State Medicaid Plans Rely on Private Plans
Kaiser Health News examines strategies states are using to manage the increase in burdens resulting from expanded eligibility under provisions of the Affordable Care Act. Among the responses; increased use of private health plans and ramping up efforts to divert long term care spending to home and community-based care. 

Illustrating the Money Flow in Prescription Drugs
Drug Channels publisher, Dr. Adam Fein, collaborating with Kaiser Health News, produced an illustration of how money flows between manufacturers, wholesalers, pharmacies and PBMs during the complex transactions that characterize the modern marketplace. 

PA Dept of Health Issues Nursing Home Task Force Report
The Pennsylvania Dept of Health released the report of the Nursing Home Task Force. The report examines the state of the state's 700 nursing homes and identifies specific areas for improvement. The major areas concern how the state conducts surveys, how it licenses nursing homes, how staffing of facilities can be improved and how data can be shared among state agencies.

CMS Looking at Revised Payment Methodology for SNFs:  Since 1998, Medicare has paid for services provided by skilled nursing facilities (SNFs) under the Medicare Part A benefit on a per diem basis through the skilled nursing facility prospective payment system (SNF PPS). Currently, therapy payments under the SNF PPS are based primarily on the amount of therapy provided to a patient, regardless of the specific patient characteristics and care needs. CMS has contracted with Acumen, LLC to identify potential alternatives to the existing methodology used to pay for services under the SNF PPS. While originally focusing on therapy, CMS has directed Acumen to examine potential improvements and refinements to the overall SNF PPS payment system. Acumen is therefore also examining payment for nursing and non-therapy ancillary services which include payment for pharmacy. Acumen has conducted 4 Technical Expert Panels, the latest one on October 14. See all Acumen reports to dateCMS will be posting a report on the October 14 TEP.

Telepharmacy: Does it make business sense?
If you've been thinking about telepharmacy as an option for expanding your practice, you may have wondered whether it makes business sense. This opinion piece at makes the point that rural areas have experienced a reduction in the number of pharmacies available and notes that telepharmacy may be the right answer for many Americans.

City Requires Pharmacies to Collect Unused Drugs
Drug Topics reports that Santa Cruz, California will begin requiring pharmacies and drug manufacturers to collect and dispose of unwanted drugs. The ordinance took effect on September 12, but the city set a deadline of November 12 for pharmacies to submit a compliance plan. The article notes that nine counties in California have passed similar legislation and the Supreme Court has refused to hear an appeal by manufacturers to overturn the law.

New Device Increases Drug Compliance
Pharmacy Practice News reports on a new medication dispensing device, manufactured by Philips, the Dutch electronics giant, that has demonstrated a 94 percent drug compliance rate among patients who used the device.

Nursing Home Residents Endangered by Medicaid Approval
Kaiser Health News reports on the difficult and lengthy process for a nursing home resident to be approved for Medicaid following a Medicare-covered stay. The story links to several news articles that relate stories of nursing home residents being discharged because they were unable to get a timely approval for Medicaid status.

Unnecessary Health Services for Seniors
The Dartmouth Atlas Project has produced a report highlighting four areas of health services that are generally not needed for the senior population. 

As reported in Managed Healthcare Executive, the report includes prostate screening in men over age 75, breast cancer screenings for women over 75, the use of antipsychotic drugs in treatment of dementia and tight glycemic control.

NCPA Hosts New Innovation Center: The National Community Pharmacists Association has created a new Innovation Center, focused on helping pharmacists identify new professional opportunities and working to get these services reimbursed. See the story in Drug Topics

Assessing the Economic Impact of New Medications: The University of Colorado Skaggs School of Pharmacy (CePOR) and the Institute for Clinical and Economic Review (ICER) have formed a collaboration to Model the Clinical and Economic Impact of New Medications. CePOR is renowned for its research excellence in pharmacoepidemiology and pharmacoeconomics, and ICER is a leader in producing reports that address the clinical effectiveness, cost-effectiveness, and potential budgetary impact of high-profile interventions. As part of the agreement, CePOR researchers will develop cost-effectiveness models for several drugs that are soon-to-be or recently approved by the FDA, leveraging evidence synthesis work performed by ICER and publicly-available data. See announcement and brief article 

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